Revenue cycle management in the behavioral health field is constantly evolving process. If your behavioral health billing organization is not up to date with the many intricacies of the insurance billing processes you are subject to extreme losses in revenue as well as a disservice to your patients.
The key areas of billing insurance:
- Verification of benefits
- Claim management
- Authorizations and utilization reviews
- Denials and appeals
- Claim reconciliation and accounting
- In this article we will break down each area and show you how to improve your revenue cycle management for your substance abuse and/or mental health treatment center.
Verification of Benefits
There are many downfalls with the verification of benefits process. Inaccurate benefit quotes, unknown information that is not provided by the insurance carrier, knowing paid amounts of each insurance carrier/policy etc.
One way to ensure you are receiving accurate benefits is to utilize verification of benefit experts who know and understand the many nuances of each insurance carrier. Having the ability to ensure you are getting a comprehensive verification of benefits quotes can make or break your behavioral health billing organization. Elevated Billing Solutions recommends that you research the different insurance payers and have a full understanding of the benefits being quoted. If the verification of benefits process is not done correctly every other aspect of the revenue cycle management process will not be able to move forward successfully.
Managing claims can be one of the most time consuming tasks associated with behavioral health insurance billing and management. Claims often seem to fall by the way side if diligent management processes are not being enforced.
Your processes should include a plan of action for each scenario that can occur with a claim being processes. What if the claim is denied? What if the claim is taking longer than average to process? You must have policies and procedures surrounding these issues.
Another aspect of the claims management process is the frequency in which you are contacting the insurance company to find out where claims are. Many billing organizations or departments have a passive approach to managing claims. Having an active process to managing claims reduces aging claims, increases cash flow and speeds up denials management.
Authorizations and Utilization Reviews
One of the key aspects of pre-authorizations and utilization reviews is having well rounded masters level clinicians trained specifically in these processes. Clinicians are not trained in their masters program to manage insurance in any shape way or form. Unfortunately, this puts the majority of clinicians at a disadvantage for obtaining adequate authorizations for patients.
In order to assist with ensuring competency in your clinician you must have a specialized training program in place that will educate them on how to effectively obtain authorizations as well as continued stay reviews.
Have one of your clinicians dedicate time to reviewing and understanding patient placement criteria among the different insurance payers is a must. Keep in mind not all insurance carriers utilize ASAM placement criteria. You must familiarize yourself with the criteria and make sure you know the requirements prior to attempting to obtain authorization.
Denials and Appeals
Whether you are dealing with an authorization denial or a claim denial having a granular approach to denials management yields the best results. Look at the different denial reasons that are common in behavioral health billing and create a course of action for each type of denial. The course of action leads directly into the appeals process.
There are a variety of appeal methods that can be utilized when managing authorization or claim denials. Familiarizing your team with the many appeal options is crucial to overturning denials.
Detailed documentation is also a vital piece in this process. Be sure to create comprehensive notes and save a copy of all insurance correspondence between your organization and the insurance carriers.
Claim Reconciliation and Accounting
Many programs and billing organizations do not consider the importance of diligent accounting. Not only must you accurately input the payment details you must also compare the payment to the benefits plan to ensure claim payment was made accurately.
Your billing organization must have multiple quality control matrices and safeguards put in place to confirm accuracy.